Common Questions About Diet and Thyroid Health

Because dietary changes made such a great impact on my own recovery from Hashimoto’s, I have been a big advocate of using food as a tool to heal from autoimmune conditions. I’ve also seen the healing potential that comes from removing problematic foods (goodbye, gluten!) and uncovering food sensitivities.

It’s no surprise, then, that as the importance of food and diet in the treatment of a multitude of illnesses becomes more and more widespread, people are asking more and more questions about what kind of diet they should be eating to treat their own conditions.

While I definitely believe that there are certain food guidelines that will apply to the majority of people with Hashimoto’s, I do want to stress that diet is not a “cure-all” and there is no one-size-fits-all way of eating that will apply to everyone. We are all unique, with our own root causes, and we will have to do some experimenting to find the diet that makes us each feel best.

My goal is to share what I have learned over the years, through my own journey to find the diet that helped me put my own Hashimoto’s symptoms in remission, as well as through working with and hearing from thousands of other people with thyroid disease over the past several years.

In this article, I’d like to share some of the common questions I hear from people about diet and Hashimoto’s, including:

• Does going gluten free affect thyroid antibodies?
• How do I test for dairy sensitivities?
• How do FODMAPs affect Hashimoto’s?
• What are low oxalate and low histamine diets?
• Can I lose weight if I have Hashimoto’s?
• …and more!

What is the difference between Paleo and Autoimmune Paleo (aka AI Protocol, or AIP) diets?

The traditional Paleo diet is a classic elimination diet that focuses on omitting the foods that people are commonly sensitive to, in an effort to lower inflammation. It eliminates all grains (including buckwheat and rice), beans, legumes, and processed foods; and replaces them with nutrient dense foods such as organic or grass-fed meats, wild-caught fish, organic vegetables and fruits, nuts, seeds, eggs from pasture-raised hens and, depending on who you ask, dairy.

Although the Paleo diet has helped some people with Hashimoto’s recover completely, I have found that the Autoimmune Paleo (AIP) diet can be even more helpful, based on 75 percent of my readers and clients who reported a significant symptom reduction—and almost 40 percent who saw a reduction in thyroid antibodies—with this dietary protocol!

The Autoimmune Paleo (AIP) diet takes Paleo one step further and avoids:

• Dairy
• Eggs
• Soy
• Alcohol
• Caffeine
• Seaweed and other sea vegetables*
• Sugars (including honey, maple syrup, and agave)
• Processed foods
• High glycemic index foods
• All nuts and seeds (except coconut)

*I recommend avoiding sea vegetables because of their high iodine content, which may exacerbate autoimmune thyroid disease.

For more information, please read my articles on the Autoimmune Paleo diet and Paleo diet.

I have been gluten free for one year and have not seen a difference in my TPO levels. What should I do?

If a person does not see a reduction in thyroid antibodies after removing gluten, it is likely that they are sensitive to other foods, and/or have other unaddressed root causes, that go beyond diet.

A good place to start is to try an elimination diet. In contrast to other diets that simply exclude common problematic foods, an elimination diet is done to determine what particular food intolerances a person may have. Going through an elimination diet will help identify individual food triggers and specific responses to each trigger food.

During the elimination diet, the most common problematic foods are eliminated, then added back in, one at a time, while one looks out for reactions to each food and writes them down. It is one of the best ways to determine which foods are necessary to eliminate to begin to feel better and reduce thyroid antibodies. In addition to the most common offenders (gluten, dairy, soy), some people may need to eliminate less commonly problematic foods that they have developed a sensitivity to (such as avocado or coconut). Finding the foods that are causing problems may involve some trial and error, but it’s worth the process.

To dig a little bit deeper, it is possible that a gut infection is to blame for elevated antibodies, in which case, further testing and protocols will be needed.

If I’ve given up gluten, can I ever reintroduce it?

Generally, with Hashimoto’s, most people should remain gluten free long-term. That said, I have seen some people who have been able to reintroduce foods and seemingly don’t have any adverse reactions to gluten. In other cases, some people claim not to react to gluten, but have obvious gluten-related symptoms like joint pain, anxiety and Hashimoto’s flare ups; and are in denial that gluten could be a trigger for them.

If gluten sensitivity is caused by an imbalance of gut bacteria, in theory, replenishing the beneficial bacteria could deem gluten sensitivity reversible. Some individuals have reported no longer reacting to gluten after taking the Megaspore probiotic.

I’m still studying the phenomenon of reducing gluten reactions and improving digestion (maybe a book in 2022?), and I’m hoping to get to the bottom of it. Personally, I have been able to reintroduce most foods back into my diet after working on healing my gut. However, I still avoid gluten and dairy, as they are the most problematic foods for me, as well as for most people with Hashimoto’s that I have worked with.

I don’t suffer from typical dairy-related symptoms like bloating, diarrhea, acid reflux, acne, or sinus issues, but is it still possible that I may have a dairy intolerance?

Not everyone will experience the same symptoms after consuming dairy. The best way to find out is by eliminating dairy for 2-3 weeks, and then adding it back in again and watching for reactions up to 4 days after consumption. Dairy protein reactions are pretty common in those with Hashimoto’s, but it’s possible that not everyone will have the same type of immune reaction to dairy products.

Some people with Hashimoto’s may present with a celiac-like intolerance, or an IgA reaction, to milk proteins (whey and/or casein), egg proteins (ovalbumin), or soy proteins.

An IgA food intolerance works primarily in the intestines. It is an abnormal response of the intestines to certain foods in genetically predisposed individuals and results in irritation and inflammation of the intestinal tract every time that particular food is ingested. The long term result is damage to the intestines and an eventual inability to absorb nutrients. IgA food intolerances often present with gastrointestinal symptoms such as diarrhea, loose stools, constipation, malabsorption of nutrients from foods, and increased intestinal permeability and IBS. IgA intolerances may also cause acid reflux, nausea, skin rashes, acne, respiratory conditions such as asthma, nasal congestion, headaches, irritability, and vitamin and mineral deficiencies.

Another type of reaction that is common for people with Hashimoto’s is due to the fact that the proteins in cow’s milk are different than those found in human milk. A person with intestinal permeability (which is always a precursor to autoimmune disease) is likely to recognize these proteins as a foreign invader and make antibodies to protect against them.

These antibodies are mediated by the IgG branch of the immune system, sometimes called a Type IV Delayed Hypersensitivity reaction. They are generally less severe compared to IgA-mediated reactions. Eating foods that stimulate the release of the IgG antibodies and promote a Type IV Delayed Hypersensitivity response will also increase thyroid antibodies. Therefore, many people with Hashimoto’s will experience an increase in thyroid antibodies and related symptoms when consuming dairy.

Symptoms of an IgG reaction to dairy can be similar to those related to IgA reactions. Many people report respiratory symptoms clearing once dairy is removed from their diets.

I would recommend first trying an elimination diet by removing dairy for a period of time, followed by IgA and IgG testing. You can also read more about my own experience with dairy and Hashimoto’s.

You mentioned gut repair is the most important thing in Hashimoto’s – why is that when Hashimoto’s is a thyroid condition?

Hashimoto’s is an autoimmune condition that happens to affect the thyroid. The gut is where the immune system lives, so restoring gut function is key to overcoming autoimmunity.

I first came across the gut-autoimmune thyroid connection when I was trying to figure out my personal underlying triggers. I was suffering from constant bloating, irritable bowel syndrome (alternating constipation and diarrhea), stomach aches, and frequent acid reflux when I came across the work of Dr. Alessio Fasano.

Dr. Fasano uncovered the three-legged stool of autoimmunity and has revolutionized the approach to autoimmune disease. According to his research, there are three things that need to be present for an autoimmune condition to develop…

• The genetic predisposition
• A triggering agent
• Intestinal permeability, also known as leaky gut

While most doctors have relegated autoimmune disease to genes and have maintained that once triggered, the process cannot be reversed, Dr. Fasano found that upon removing the intestinal permeability and/or trigger, an autoimmune condition will go into remission!

Optimizing gut function is one of the crucial steps in optimizing immune system and thyroid function, and I’ve found that addressing leaky gut can help a person turn their health around within a short amount of time, even if they have been struggling with symptoms for many years.

Which form or source of protein is best?

Proteins are used within the body to build and repair cells and tissues, and to fuel the fight or flight response. People with chronic illness actually need more protein in their diet to help support greater repair demands. When you think of protein, think of your body getting more raw fuel to create thyroid hormones, patch up the leaks in your intestines, and repair your joints, skin, hair and nails.

Everybody is different, and what works for one person may not work for the next, but protein from animal meat is usually less reactive than non-meat protein sources like dairy, gluten-containing grains, soy, nuts, or eggs. I generally recommend that most people with Hashimoto’s get their protein from meat sources at the volume of about 1-1.2 grams of protein per kilogram of body weight per day (roughly 0.5 grams per pound of body weight).

In addition to getting protein from foods, it may also be helpful to obtain protein from protein powder. As people with Hashimoto’s often have deficiencies in digestive enzymes, they may have trouble extracting protein and various nutrients from the foods that they’re eating. Because it has already been broken down into fine form and separated from other ingredients, protein from powder is generally easier to digest than protein from foods.

The problem with most varieties of protein powder on the market, however, is that they often contain dairy and/or soy, which are highly reactive foods in many of those with Hashimoto’s.

The three types of protein powders I’ve found to be the most likely tolerated by people with Hashimoto’s are: hydrolyzed beef protein, pea protein, and hemp protein. Pea protein and hemp protein are plant based proteins. However, while generally well tolerated, they are not complete proteins (they don’t contain all essential amino acids), and hemp protein may be problematic for some people with estrogen dominance concerns. Of the three, hydrolyzed beef protein is the best tolerated.

After many years of encouragement from my readers, I finally developed my own Rootcology AI Paleo Protein (unflavored hydrolyzed beef), Paleo Protein (hydrolyzed beef, vanilla flavor), and Organic Pea Protein powders to provide an easily absorbed protein source for people with Hashimoto’s.

What are FODMAPs and how do they affect Hashimoto’s?

FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) are found in foods such as wheat, soy and other legumes, certain fruits and vegetables, dairy, and sweeteners such as fructose and high fructose corn syrup.

The low FODMAP diet is considered an effective nutritional therapy for certain digestive disorders, including Small Intestinal Bacterial Overgrowth, or SIBO. One small study reported that about 50 percent of people with hypothyroidism have SIBO. SIBO can be a root cause of Hashimoto’s and can lead to intestinal permeability and irritable bowel syndrome.

Symptoms such as bloating, gas, diarrhea, and/or constipation are common in SIBO, and may be exacerbated by eating foods that contain FODMAPs.

By removing foods high in FODMAPs, this diet essentially cuts off the food supply to the bacteria that may be growing out of control in the intestines. The Low FODMAP dietary approach has been shown to be potentially effective in treating symptoms of SIBO-induced IBS, and about 39 percent of people with Hashimoto’s reported feeling better on a low FODMAP diet.

Read this article for more information on SIBO and FODMAPs.

How do I lose weight with Hashimoto’s and hypothyroidism?

Weight gain is a common symptom of thyroid disease, as your thyroid, adrenals and nutrient levels each play a big role in unexpected weight gain. There are many areas to address if you are trying to lose weight with Hashimoto’s, but here are a few things to consider when starting your health journey:

1. What were your recent TSH, free T3, and free T4 levels? Sometimes when those numbers are on the outskirts of normal, your metabolic rate may be impaired, making it more difficult for you to burn calories. Most people report feeling well with a TSH between 0.5-2 μIU/mL.
2. What type of medication are you on? Some report more weight loss with a T4/T3 combination vs. T4 alone. Some also do not convert T4 properly.
3. What type of diet are you eating? The Standard American Diet (S.A.D.), full of sugar and simple carbohydrates, is perfectly designed to cause us to gain weight year after year. Even yogurts that are marketed as “healthy” contain the equivalent of 16 teaspoons of sugar per serving! Divorcing the S.A.D. is often a step that many of us must take to not just lose weight, but to also feel better. Some diets that have been helpful include the Paleo diet, the Autoimmune Paleo diet (AIP), and gluten free diets. For more information about finding the right diet for you, please take a look at this article about the best diet for Hashimoto’s. You may need to modify these diets to your own individuality. (If you’re curious about the AIP diet, sign-up for your free 2-week recipe plan!)

For more strategies, please read my article on losing weight with Hashimoto’s.

Should I follow a set macronutrient ratio?

I don’t recommend a set macronutrient ratio (carbohydrates/fats/proteins) for everyone. Instead, I often advise people to experiment with their fat to protein to carb ratios, to find the way of eating that works best for their individual bodies and lifestyles. Some people who are more active may benefit from higher levels of protein.

Others who are dealing with brain fog, pain, depression or hormonal imbalances may benefit from more fats. For most people with Hashimoto’s, I do recommend keeping carbohydrates lower to help balance blood sugar. However, everyone will need to adjust their diet to their individual needs, and those needs may change.

Can I ever eliminate my food sensitivities and reintroduce foods?

While eliminating potentially problematic foods in order to address food sensitivities is often times an important step towards healing, the good news is that many of the foods can be added back into your diet someday. Once the sensitizing foods have been removed from your body, your gut is given the chance to begin the healing process. When the immune response to that particular food has subsided (this can take up to 6 months), and gut health has been restored, you can try reintroducing the food and note how your body responds. I recommend going slow and allowing at least 4 days between reintroduced foods to observe if you have any reactions.

Gluten and dairy, however, are two foods that most people with Hashimoto’s will need to eliminate for the long haul. Even after I healed my own gut and reintroduced all other previous food sensitivities, I continue to avoid gluten and dairy. A small number of people will be able to tolerate reintroducing those foods, however, and you can test them for yourself by trying a small portion and noting what reactions you have.

What about the low histamine, low oxalate, and Candida diets in conjunction with the AIP/Paleo diets?

Low oxalate diet: There is some evidence that oxalates, substances that are found in some foods, and are also waste products made by our bodies and excreted through our kidneys, may play a contributing role in Hashimoto’s. While a standard diet takes in about 250 mg of oxalates, a low oxalate diet may offer some people relief from symptoms. When following a low oxalate diet, consuming under 100 mg is recommended, but under 50 mg is ideal, unless your doctor suggests otherwise.

Oxalate sensitivity should be suspected if, in addition to a thyroid condition like Hashimoto’s or Graves’, you experience joint pain, pain in the body, burning with urination (interstitial cystitis), burning with bowel movements, depression, or kidney stones. Please see my article on oxalates and Hashimoto’s for more information on how to incorporate a low oxalate diet into your current diet.

Candida diet: Candida diets can be similarly helpful for people with Hashimoto’s, as Candida yeast overgrowth is a potential trigger for Hashimoto’s. Candida is a form of yeast that is naturally found in a person’s mouth, intestines, and for women, the vaginal tract. The problem occurs when there is an imbalance between Candida and other microorganisms in the body that can turn Candida into an opportunistic fungal infection that can overgrow and cause permeability to the intestinal tract.

Symptoms of Candida overgrowth include fatigue, bloating, gas, belching, diarrhea or constipation, endometriosis, infertility, mood swings, insomnia, bad breath, pain in muscles or joints, weakness, brain fog, and vaginal burning or itching.

A Candida diet works to starve the fungus by cutting out simple carbohydrates in addition to nuts, seeds, grains, corn, mushrooms, potatoes, fruits, dairy, and alcohol. For more information about the types of Candida diets that may work for you, please read my article on Candida and Hashimoto’s.

Low histamine diet: Because high histamine levels can be caused by SIBO and intestinal permeability (or leaky gut), there is a population of people with Hashimoto’s who might find some relief by trying a low histamine diet.

Histamines are an inflammatory response in the body that can be a reaction to a range of substances that the body perceives as an attack. For some, this appears as seasonal allergies, while others might experience food allergies. If you don’t break down the histamine properly, your body can develop an intolerance to histamines. Common symptoms include headaches/migraines, insomnia, hypertension, vertigo or dizziness, accelerated heart rate, difficulty regulating body temperature, anxiety, nausea, abdominal cramps, skin flushing, nasal congestion, sneezing, difficulty breathing, hives, fatigue and tissue swelling.

By avoiding foods high in histamine, most people are able to overcome their histamine intolerances after a period of time and add these foods back into their diet. High histamine foods include alcoholic beverages, fermented foods, vinegar, cured meats, dried fruits, citrus, aged cheese, some nuts, avocado, spinach, tomatoes, eggplant and certain species of fish.

Is there anything I can do dietary-wise to feel better?

Absolutely! I have written extensively on dietary approaches to feeling better and putting Hashimoto’s into remission, as I have seen it work so well in my own body, and with thousands of clients.

A great place to start is with eliminating food sensitivities. This might mean trying an elimination diet to cut out possible problematic foods. (Gluten-containing grains, dairy, corn and soy tend to be the worst offenders.) Many people will feel better by simply taking these highly irritating foods out of their diet. The next step would be to do some food sensitivity testing to find the hidden foods that you are intolerant to.

A further step would be to work on balancing blood sugar by eating a diet high in healthy fats and protein, while reducing sugar and carbohydrate intake. The Autoimmune Paleo diet is a great diet to start with, as it focuses on foods like non-starchy vegetables, low glycemic index fruits, and meats. You can also read my article on finding the best diet for you.

Where can I get more information about diet and Hashimoto’s?

While I do believe that foods can be used to heal, I want to reiterate that I don’t believe there is a “one-size-fits-all-diet” that will be a cure-all for everyone. You will need to experiment with different protocols to find what works for you.

However, because I have found that there are many protocols that have worked well for a large number of people with Hashimoto’s, I have put together many resources for my readers in hopes that you, too, can find the resources you need to feel better again. I encourage you to search the Thyroid Pharmacist website, where I have hundreds of articles on diet and Hashimoto’s.

My book, Hashimoto’s Protocol, contains a clear action plan for healing from Hashimoto’s, including many dietary protocols that you can begin implementing immediately. I’ve also created a cookbook which I released in March 2019 that digs further into my dietary philosophy and contains over a hundred recipes to help you thrive as you heal. You can check it out here.

It’s also important to remember that sometimes we have to dig deeper to find our root causes. While the symptoms you are experiencing could mean that you are having a reaction to foods, they could also mean that you have deficiencies in nutrients or digestive enzymes, or you have other root causes like intestinal infections, toxicities or an impaired ability to handle stress. It’s easy to get stuck on the idea that “diet can heal everything”, and that if we remove more foods, we’ll be healed—but this isn’t always the case. Sometimes we have to dig deeper to get to our root cause before we start to feel better.

As always, I am here to support you on your health journey and hope that some of these resources help you find the diet and interventions that will make you feel better. Feel free to ask your own questions about diet and Hashimoto’s in the comments below, or on my Facebook page!

P.S. You can also download a free Thyroid Diet Guide, 10 thyroid friendly recipes, and the Nutrient Depletions and Digestion chapter of my Root Cause book for free by signing up for my weekly newsletter. You will also receive occasional updates about new research, resources, giveaways, and helpful information.

Note: Originally published in November 2015, this article has been revised and updated for accuracy and thoroughness.